Surveillance for Pregnancy and Birth Rates
Among Teenagers, by State -- United States,
1980 and 1990

Alison M. Spitz, M.S., M.P.H. (1)

Stephanie J. Ventura, A.M. (2)
Lisa M. Koonin, M.N., M.P.H. (1)

Lilo T. Strauss, M.A. (1)

Alice Frye, M.P.H. (1)
Robert L. Heuser, M.A. (2)

Jack C. Smith, M.S. (1)
Leo Morris, Ph.D., M.P.H. (1)

Sandra Smith, M.P.H. (2)
Phyllis Wingo, Ph.D., M.S. (1)

James S. Marks, M.D. (1)

Abstract

Problem/Condition: In the United States in 1990, there were an
estimated 1
million pregnancies and 521,826 births among women ages 15-19
years. Rates
of teenage pregnancy and birth rates by state in 1990 exceeded
those in
most developed countries. An estimated 95% of teenage pregnancies
are
unintended (i.e., they occur sooner than desired or are not wanted
at any
time).

Reporting Period Covered: This report summarizes and reviews
surveillance
data for pregnancies, abortions, and births among women ages 15-19,
15-17,
and 18-19 years reported by CDC for 1980 and 1990.

Description of System: Data for births and abortions were reported
to state
health departments and other health agencies and sent to CDC. The
data from
each state included the total number of births and abortions by age
and
race/ethnicity.

Results: Data in this report indicate that pregnancy rates by state
among
U.S. teenagers ages 15-19 years have changed little since 1980.
Moreover,
many states have reported increases in birth rates that are
probably
related to concurrent decreases in abortion rates. Pregnancy rates
range
from 25 to 75 per 1,000 for 15- to 17-year-olds and from 92 to 165
per
1,000 for 18- to 19-year-olds.

Interpretation: States with low rates of teenage pregnancy or birth
may
have developed and used prevention strategies directed at the needs
of both
younger and older teenagers; these programs may serve as models for
other
states where birth rates have remained high or have increased since
1980.

Actions Taken: CDC will continue to conduct surveillance of and
analyze
data for pregnancies, abortions, and births among teenagers to
monitor
progress toward national goals and to assist in targeting program
efforts
for reducing teenage pregnancy.

INTRODUCTION

An estimated 1 million pregnancies and 521,826 live births
among U.S.
women ages 15-19 years were reported for 1990 (1,2). Because of the
adverse
health, social, and economic consequences of teenage childbearing,
CDC
analyzed data for pregnancies and births among teenagers (3). These
data
will be used to monitor progress toward national goals and to
assist in
targeting program efforts to reduce teenage pregnancy (4). An
earlier
report presented 1990 pregnancy and birth rates for teenagers ages
15-19 by
state and race/ethnicity and compared those rates with those for
1980 (5);
this report makes the same comparisons with more detailed age
groups for
the 15- through 19-year-old population (6,7). Data for teenagers
less than
15 years of age will be presented in a future report.

METHODS

For this report, rates of teenage pregnancy were defined as
the sum of
live births and legal induced abortions per 1,000 women ages 15-19,
15-17,
and 18-19 years; rates were also analyzed by racial/ethnic group.
These
rates do not include estimates of spontaneous abortions or
stillbirths,
primarily because fetal losses are substantially underreported to
state
health departments. Although national estimates indicate that
approximately
12% of pregnancies among U.S. teenagers end in fetal loss (2), no
comparable data are available at the state level.

Birth rates among teenagers were defined as the number of live
births
per 1,000 women ages 15-19, 15-17, and 18-19 years in their
respective
racial/ethnic group. Abortion rates were defined as the number of
legal
induced abortions per 1,000 women in those age and racial/ethnic
groups.
Information about births was obtained from birth certificates;
state
reports to CDC provided information on abortions. Numbers of women
used to
calculate rates were obtained from unpublished tabulations provided
by the
U.S. Bureau of the Census. Births were reported by state of
residence;
since abortion data by residence were not available for all states,
abortions were reported by state of occurrence. Thus, pregnancy and
abortion rates for states with substantial numbers of abortions
among
nonresident women may be somewhat higher than rates based on
abortions by
residence.

Because the numbers of abortions by age were not available for
all
states in 1990, pregnancy rates for all women ages 15-19 years in
1990 were
calculated for the District of Columbia (DC) and for the 40 states
from
which information for age was available. * Pregnancy rates for
detailed age
groups and for race/ethnicity were calculated for states reporting
data by
those categories. Birth rates were calculated for all 50 states and
DC for
all three age groups. Detailed information has been tabulated on
the states
reporting data for abortions and births by various age and
racial/ethnic
categories (Appendix).

Rates by race/ethnicity were not reported if there were less
than or
equal to 20 abortions or births or less than or equal to 1,000
women in the
specified group or if greater than or equal to 15% of abortions
were among
women of unknown race/ethnicity. These exclusions are noted in the
tables.
** Furthermore, rates for racial/ethnic groups other than white,
black, and
Hispanic were not calculated because abortion data were not
available or
because the numbers of births were too small at the state level for
reliable rates to be computed. Data analyzed by race/ethnicity may
be
useful for targeting educational and family planning programs for
reducing
pregnancy among teenagers.

Hispanic women and infants born to Hispanic women may be of
any race.
Although both race and Hispanic origin were reported separately on
1990
state birth certificates and in the census, information for
abortions in
1990 (reported by states to CDC) did not designate race
independently of
Hispanic ethnicity. Thus, for this analysis, pregnancy and abortion
rates
for whites include all abortions for Hispanics. *** For most
states, rates
will be affected minimally because the majority of states have
small
numbers of Hispanic women. However, for states with relatively
large
Hispanic populations, such as Texas, the rate for white women may
reflect
to a considerable degree the rate for Hispanics.

Differences mentioned in the text in rates in 1990 compared
with 1980
are statistically significant at the 0.05 level. The categories of
percent
changes in rates from 1980 to 1990 are based on rounded numbers.

RESULTS

Rates of Pregnancy, Abortion, and Birth by Age Group

In 1990, pregnancy rates by state among women ages 15-19 years
ranged
from 56 to 111 per 1,000 women **** (Table_1). Rates for the
younger
teenagers in this age group (15-17 years) showed proportionately
greater
variation, ranging from 25 to 75 per 1,000. Rates for older
teenagers (18-
19 years) were much higher than those for younger teenagers,
ranging from
92 to 165 per 1,000.

Abortion rates reported by states **** for women ages 15-19
years
varied more than pregnancy rates, ranging from 6 to 49 abortions
per 1,000
women (Table_2). Rates for women ages 15-17 ranged from 3 to 34
per
1,000, while abortion rates for women ages 18-19 ranged from 10 to
68 per
1,000 (Table_2).

Birth rates among women ages 15-19 years ranged from 33 to 81
per
1,000 women **** (Table_3). For young teenagers ages 15-17,
rates
ranged from 16 to 57 per 1,000 women. Again, rates for older
teenagers were
higher than those for younger teenagers, ranging from 47 to 124 per
1,000
women ages 18-19.

Rates of Pregnancy, Abortion, and Birth by Race/Ethnicity

Pregnancy and birth rates for blacks were generally higher
than rates
for Hispanics and whites (Table_4 and Table_5). However,
data were
not available to permit adjustments for socioeconomic or
educational status
of mothers. Pregnancy rates for teenagers ages 15-19 years ranged
from 104
to 219 per 1,000 for blacks in the 24 states for which rates could
be
calculated; from 56 to 145 per 1,000 for Hispanics (19 states); and
from 46
to 106 per 1,000 for whites (30 states).

In 1990, pregnancy rates for black teenagers ages 15-17 years
were
generally 2 to 3 times the rates for white teenagers in that age
group
(Table_4). Rates for Hispanic teenagers generally were between
those
for white and black women. These differentials were observed for
older
teenagers as well.

Abortion rates for black teenagers were generally 1.5 to 3
times the
rates for white teenagers, but in some states the rates were
similar.
Abortion rates for Hispanic teenagers generally were lower than
those for
either white or black women.

Patterns in birth rates by racial/ethnic group for women ages
15-19
years were similar to patterns in pregnancy rates, although rates
for
Hispanics were closer to those for blacks. For some states, birth
rates for
blacks were 2-5 times the rates for whites (Table_5). These
patterns
were also observed for women ages 15-17 and 18-19.

Rates of Pregnancy, Abortion, and Birth by Age Group,
1990 Compared with 1980

For 1990 compared with 1980, pregnancy rates for women ages
15-19
years showed a statistically significant decline in 20 of the 40
states and
in DC (Table_6 and Figure_1). However, rates in 14 of these
21
areas declined by less than or equal to 10%. Over the decade,
pregnancy
rates increased in 13 states, and six of these states reported
increases
greater than 10%.

Pregnancy rates for teenagers ages 15-17 years declined in 18
of the
40 states for which rates were computed (Table_7). Trends in
rates for
teenagers ages 18-19 were remarkably similar to those for the
younger
teenagers, except that the range of the percent changes was smaller
for the
older teenagers (Table_8).

Abortion rates reported for states were more likely to show
declines
than were pregnancy rates, and those declines were proportionately
larger
(Table_6). Declines in abortion rates for women ages 15-19
years were
observed in 26 of the 40 states and in DC. In 24 of these 27 areas,
the
declines were greater than 10%; 15 states reported declines of
greater than
20%. Abortion rates increased in nine states, with increases of
greater
than 10% in six of these states.

Abortion rates for teenagers ages 15-17 years showed the same
patterns
as pregnancy rates. Rates decreased in 26 of the 40 states; in 22
of these
states, the declines exceeded 20%. Abortion rates for the older
teenagers
also declined in 26 of the 40 states; the declines exceeded 20% in
11 of
these states.

Unlike pregnancy and abortion rates, birth rates in most
states
increased in 1990 compared with 1980. Because the declines in
abortion
rates generally exceeded those in pregnancy rates, birth rates for
women
ages 15-19 years increased in 29 states and in DC (Table_6 and
Figure_2). Rates in 18 of the 30 areas increased by greater
than 10%;
in 10 areas, rates increased by greater than 20%. Birth rates
declined in
only 13 states; in seven of these, declines exceeded 10%.

Birth rates by state for younger teenagers (ages 15-17 years)
were
also more likely to increase (23 states and DC) than to decline
(nine
states) (Table_7). This increase also was noted for the older
teenagers
(ages 18-19 years); rates increased in 24 states and DC and
declined in 14
states (Table_8). Increases tended to be smaller for the older
age
group than for the younger.

Pregnancy and abortion rates and relative changes over time in
these
rates affect the birth rates and the percent change in these birth
rates in
a given area. To illustrate how the varying patterns of change in
pregnancy
and abortion rates affect changes in the birth rate in a given
state, we
discuss these rates for 15- to 19-year-olds in three states:
Nevada, North
Dakota, and Rhode Island (Figure_3).

The pregnancy rate in Nevada declined by 9% in 1990 compared
with
1980, but the abortion rate decreased by much more (43%); the net
result
was a 25% increase in Nevada's birth rate. In North Dakota, changes
in
pregnancy, abortion, and birth rates were more consistent; the
pregnancy
rate declined by 23% and the abortion rate decreased by 34%. The
birth rate
in this state also declined, but to a lesser extent (15%). A
different
pattern is illustrated by Rhode Island, where the pregnancy rate
increased
by 17%, but the abortion rate did not change. As a result, the
birth rate
increased by 33%. These illustrations demonstrate that a change in
either
the pregnancy or abortion rate can change the overall birth rate in
any
state.

Rates of Pregnancy, Abortion, and Birth by Race/Ethnicity,
1990 Compared with 1980

Pregnancy, abortion, and birth rates for white and black
teenagers for
1990 compared with 1980 differ considerably (Table_9 and
Table_10).
Data for 1990 and 1980 for Hispanic women were not examined because
only 22
states reported Hispanic origin on the 1980 birth certificates and
because
abortions were not classified by Hispanic origin in 1980.
Generally,
pregnancy and abortion rates for white teenagers ages 15-19 years
were more
likely to decline than to increase; the opposite was true for black
women.
Birth rates for both white and black women were more likely to
increase
than decline, but for white women the increases occurred in
relatively
fewer states.

Pregnancy rates for white teenagers ages 15-19 years decreased
in 15
of 25 states; in eight states, declines were greater than 10%
(Table_9). Abortion rates for white teenagers decreased in 16
of the 25
states; the rates decreased by greater than 10% in all of these 16
states;
rates for 14 states declined by greater than 20%. Birth rates for
white
teenagers increased in 25 states (by greater than 10% in 15 states)
and
decreased in 16 states and DC.

Among black teenagers ages 15-19 years, pregnancy rates
increased in
13 of 19 states and declined in one state (Table_10); the
increase was
greater than 10% in 10 states. Abortion rates for black teenagers
were also
more likely to increase (10 states) than to decline (four states).
Birth
rates for black teenagers increased (for the most part,
substantially) for
DC and for 28 of the 39 states for which rates were computed for
both 1980
and 1990. Birth rates rose by greater than 10% in 22 of the states
and in
DC; 14 states and DC reported increases of greater than 20%.

DISCUSSION

Trends in Pregnancy, Abortion, and Birth

Pregnancy and birth rates among teenagers in the United States
exceed
those in most developed countries (8; Alan Guttmacher Institute,
unpub-
lished data, 1988). Small declines in pregnancy and birth rates
among
teenagers during the early 1980s subsequently reversed, resulting
in
relatively little net change in the U.S. pregnancy rate in this age
group
over the decade (1,2). ***** Recent data indicate that the teenage
birth
rate increased almost 20% from 1986 through 1990, whereas the
abortion-to-
live-birth ratio among teenagers decreased by about 21% during the
same
period. These trends suggest that a larger proportion of
pregnancies among
teenagers ended in live births (1,9).

Although pregnancy rates among U.S. teenagers did not decline
during
the 1980s and may have increased in recent years, the actual number
of
pregnancies among teenagers declined by about 14% from 1980 through
1988,
as the number of teenage women declined (2). Women who were
teenagers in
the late 1980s were born during the early 1970s, after the baby
boom and
during a period when birth rates dropped to historic low levels.

Age

This report demonstrates wide state-to-state variation in
pregnancy,
abortion, and birth rates among teenagers in 1990 as well as in
1980. The
variation in these rates for 15- to 19-year-olds reflects the
proportion-
ately wider range of such rates among younger teenagers (ages 15-17
years)
compared with older teenagers (ages 18-19 years). This diversity,
evident
among all women and subgroups, may partly reflect higher levels of
unintended pregnancy among women ages 15-17 than among women ages
18-19.

National health objectives for the year 2000 include reducing
the
pregnancy rate for teenagers ages less than or equal to 17 years to
less
than or equal to 50 per 1,000 women (4). Nearly half the states
that have
these data available have reached this goal. In some states,
teenagers ages
15-19 have pregnancy or birth rates as low as those in several
developed
countries (8; Alan Guttmacher Institute, unpublished data, 1988).
Such
states may have developed and used prevention strategies directed
at the
needs of both younger and older teenagers; these programs may serve
as
models for other states.

Race/Ethnicity

Factors that affect pregnancy and birth rates for all women
and for
women by racial/ethnic groups include trends in sexual experience
among
teenagers, socioeconomic status, access to family planning and
abortion
services, and the use of contraception. For example, a recent study
indicated that, although sexual activity among white teenagers
increased
considerably during the 1980s, the use of condoms at first
intercourse rose
sharply as well; sexually experienced white teenagers were thus
less likely
to become pregnant in 1988 than in 1980 (2). However, during
1983-1988,
Hispanic and black women were less likely than white women to use
contra-
ception during their first reported premarital sexual intercourse
(32% and
58%, compared with 70%) (10). Trends in these factors bear further
analysis.

An important factor in the rapid increase in birth rates for
white
teenagers during the 1980s is the growing proportion of these women
who are
Hispanic (11). Hispanic women have much higher birth rates at all
ages than
do non-Hispanic white women, but particularly at ages less than 20
years
(1). For example, the birth rate among teenagers for 1990 was 100
per 1,000
for Hispanics, compared with 43 per 1,000 for non-Hispanic whites.
Moreover, the Hispanic teenage population increased 12% from 1986
through
1990, while the non-Hispanic white teenage population declined 10%.
Thus,
the sustained increase in the birth rate among white teenagers
since the
mid-1980s partly reflects the combined impact of the higher
fertility of
Hispanic white teenagers and the growing proportion of the white
teenage
population that is Hispanic.

Data Limitations

We could not calculate pregnancy rates among teenagers for
1990 in 10
states because those states did not collect data on the age of
women
obtaining abortions. These 10 states accounted for approximately
39% of all
U.S. abortions in 1990. Because so many pregnancies among teenagers
-- more
than a third -- end in abortion and because the rates vary widely
by state,
complete abortion reporting from each state by age and
race/ethnicity is
essential for monitoring national and state-specific pregnancy
trends among
teenagers.

Consequences

The personal and social impact of pregnancy among teenagers in
the
United States is enormous; an estimated 95% of such pregnancies are
unintended (i.e., they occur sooner than desired or are not wanted
at any
time) (2,12). From 1985 through 1990, the public costs (e.g.,
through Aid
to Families with Dependent Children, Medicaid, and food stamps)
related to
teenage childbearing totaled $120.3 billion (13). Of this amount,
an
estimated $48.1 billion could have been saved if each birth had
been
postponed until the mother was at least 20 years old. Although the
cost-
benefits of family planning services have not been estimated
specifically
for teenagers, it is estimated that for every public dollar spent
on family
planning services for all women, an average of $4.40 is saved by
averting
expenditures for medical services, welfare, and nutritional
services (14).
These expenses are likely even greater for teenagers, who are at
increased
risk for pregnancy complications and whose financial resources are
usually
more limited than those of older women.

Public Health Implications

More than 70 national health and social welfare organizations
support
age-appropriate, comprehensive school health education programs to
reduce
pregnancy among teenagers (15). These programs counsel abstinence
as well
as provide teenagers with the knowledge and skills they need to
avoid
unplanned pregnancy. In addition to health education efforts,
family
planning services for sexually active teenagers are important for
reducing
pregnancy among teenagers (4).

CDC. Teenage pregnancy and fertility in the United States:
1970, 1974,
and 1980: regional and state variations and unintended
fertility.
Atlanta: US Department of Health and Human Services, Public
Health
Service, CDC, 1987.

US Congress, Office of Technology Assessment. International
health
statistics: what the numbers mean for the United States --
background
paper. Washington, DC: US Government Printing Office, November
1993.
(No. OTA-BP-H-116).

Bureau of the Census. United States population estimates, by
age, sex,
race, and Hispanic origin: 1980 to 1991. Washington, DC: US
Department
of Commerce, Bureau of the Census, 1993. (Current population
reports;
series P-25, no. 1095).

* For states with <15% unknown information on age or race, unknowns were redistributed based on known distributions. Thus, many numbers and rates that resulted from these redistributions differ slightly from those published in recent reports (5,9).

** When rates are not reported, the reason for their exclusion
is listed in the table according to the following hierarchy:
a)
abortion data not available; b) less than or equal to 20
births or
abortions or less than or equal to 1,000 women; and c)
greater than
or equal to 15% unknown race/ethnicity in abortion data.

*** Ninety-seven percent of Hispanic women who had a live birth
in 1990 were white (1).

**** DC is not included in these comparisons. Its pregnancy and
abortion

rates were higher than those of any state, in part because
large
numbers of nonresidents had abortions there in 1980 and
1990.

***** The National Center for Health Statistics used abortion
estimates reported by the Alan Guttmacher Institute (AGI) to
calculate
national teenage pregnancy rates through 1988 (2). For that
report,
because age-specific data were not available from AGI,
abortion
estimates by age were derived from abortion data compiled
by CDC's
National Center for Chronic Disease Prevention and Health
Promotion
on the characteristics of women obtaining abortions.

APPENDIX

Information presented in this report is based on abortion and
birth
data compiled by state health departments and reported to CDC.
Pregnancies
are computed as the sum of abortions and live births in a specified
group.
Pregnancy rates could not be calculated for all states because of
missing
abortion data. Table_1A

An additional statistical limitation on the data shown in
Tables 1-10
in the text is based on the available numbers of events and the
numbers of
women in a specified group. That is, rates were not computed if
there were
less than or equal to 20 abortions or births, if there were less
than or
equal to 1,000 women in the specified group, or if greater than or
equal to
15% of abortions were obtained by women of unknown race/ethnicity.
These
statistical limitations are indicated in the tables.

Table_1Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size.

DisclaimerAll MMWR HTML versions of articles are electronic conversions from ASCII text into HTML. This conversion may have resulted in character translation or format errors in the HTML version. Users should not rely on this HTML document, but are referred to the electronic PDF version and/or the original MMWR paper copy for the official text, figures, and tables. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800. Contact GPO for current prices.

**Questions or messages regarding errors in formatting should be addressed to mmwrq@cdc.gov.